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Individual

ELIZABETH GAY CULLUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
OT

Contact information

Practice address
812 S PARK ST, CARROLLTON, GA 30117-4412
(770) 834-7436
Mailing address
812 S PARK ST, CARROLLTON, GA 30117-4412
(770) 834-7436

Taxonomy

Speciality
Code
Description
License number
State
225X00000X
Occupational Therapist
Primary
OT006553
GA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
OT006553
GEORGIA BOARD OF OCCUPATIONAL THERAPY
GA
Enumeration date
09/26/2016
Last updated
02/12/2019
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